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Korean J Gastroenterol  <  Volume 75(4); 2020 <  Articles

Korean J Gastroenterol 2020; 75(4): 182-187  https://doi.org/10.4166/kjg.2020.75.4.182
Liver Dysfunction in Sepsis
Tae Suk Kim, Dae Hee Choi
Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea
Correspondence to: Dae Hee Choi, Department of Internal Medicine, Kangwon National University School of Medicine, 1 Kangwondaehak-gil, Chuncheon 24341, Korea. Tel: +82-33-258-9211, Fax: +82-33-258-2146, E-mail: dhchoi-md@kangwon.ac.kr, ORCID https://orcid.org/0000-0002-8956-7518
Received: March 13, 2020; Revised: April 10, 2020; Accepted: April 11, 2020; Published online: April 25, 2020.
© The Korean Journal of Gastroenterology. All rights reserved.

This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Sepsis is defined as a life-threatening organ dysfunction caused by a dysregulated host response to infection. During sepsis, the liver has essential roles, such as immune defense and metabolic adaptation to inflammation. In addition, it is a target for sepsis-related injury, including hypoxic hepatitis, cholestasis, drug-induced liver injury, and secondary sclerosing cholangitis in critically ill patients. In particular, the mortality rate due to sepsis is four times higher in patients with cirrhosis, warranting a high index of suspicion for infection, appropriate diagnosis, and prompt antimicrobial treatment. The most recent definition of sepsis (Sepsis-3) no longer uses systemic inflammatory response syndrome (SIRS) and is based on the signs of organ dysfunction, which can be assessed by the Sequential Organ Failure Assessment (SOFA) and quick SOFA (qSOFA) scores. The qSOFA score can be applied at the bedside before any tests and is believed to be suggestive of sepsis when at least two of the following criteria are met: altered consciousness, respiratory rate ≥22/min, and systolic blood pressure ≤100 mmHg. While the qSOFA score performs well in the general population, its role in cirrhotic patients is unclear. This paper briefly reviews the current knowledge of the pathogenesis, definition of sepsis, and sepsis-related liver dysfunction. Furthermore, this review summarizes the clinical applicability of Sepsis-3 in cirrhotic patients.
Keywords: Infections; Multiple organ failure; Liver cirrhosis; Sepsis-3

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